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Overview of Hospital Presumptive Eligibility

TennCare is implementing a Hospital Presumptive Eligibility (PE) process. The Hospital PE process allows qualified hospitals to determine whether applicants qualify for a period of temporary TennCare eligibility (i.e., 62 days). Qualified hospitals use TennCare Online Services to transmit to TennCare the temporary eligibility period for all persons the hospitals approve for Hospital PE. Qualified hospitals also help all applicants for Hospital PE to complete the application for full, ongoing TennCare eligibility beyond the temporary, 62-day eligibility segment. Using the Hospital PE process, participating hospitals can screen and provide immediate coverage to qualified uninsured individuals and help these patients complete the regular TennCare application process.

Qualified hospitals may only enroll individuals whom they believe meet TennCare’s eligibility rules. Those patients or individuals who would be eligible for TennCare coverage through Hospital PE must fall into one of the following TennCare categories:

  • Children (younger than age 19) who fall within the TennCare income range;
  • Pregnant women who fall within the TennCare income range;
  • Parents or caretaker relatives of dependent children who fall within the TennCare income range; and
  • Former foster care children up to age 26.

Hospitals base the PE determinations on preliminary information reported by individuals. Under the federal rules, qualified hospitals rely on self-reported information for applicants and do not ask applicants to provide verifications of any information.

Information about becoming a qualified hospital for Hospital PE.

More information about Hospital PE operations and training.

A list of hospitals participating in the Hospital PE program.

A special note regarding newborns (June 10, 2016): TennCare implemented a Newborn PE program on August 18, 2014. In the interest of expediency, we implemented the Newborn PE program without executing formal agreements with participating hospitals. In the coming months, TennCare will circulate a Newborn PE agreement, which hospitals must execute to continue to perform Newborn PE determinations. Additionally, these hospitals must begin using a new interface at TennCare Online Services later this year. However, hospitals that participate in the Hospital PE program and sign a Hospital PE agreement will not need to sign a second agreement for Newborn PE – and they can use the Hospital PE interface for all PE transactions (including those for newborns).